ECDC calls for continued action to address antimicrobial resistance in healthcare settings

On European Antibiotic Awareness Day, the European Centre for Disease Prevention and Control (ECDC) publishes the results of two point-prevalence surveys of healthcare-associated infections and antimicrobial use in hospitals and in long-term care facilities in the EU/EEA. The findings show that practices in terms of antimicrobial use vary from country to country throughout Europe and that, overall, there is room for improvement. Furthermore, healthcare-associated infections remain a serious issue, with 8.9 million occurring each year in both hospitals and long-term care facilities. Overuse of antimicrobials – mostly antibiotics – and varying infection prevention and control practices may result in the increased emergence and spread of multidrug-resistant bacteria in the EU/EEA.

Vytenis Andriukaitis, European Commissioner for Health and Food Safety, said: "The rising number of Europeans who are dying or who become disabled from infections that are resistant to antimicrobials is of great concern to me and to the European Commission. We can avoid many of these deaths by stopping the unnecessary use of antimicrobials in healthcare and in agriculture, and through better diagnosis and prevention of infection in healthcare settings and communities. I am proud of the work that our partners in EU Member States, together with the European Commission and the EU agencies, do to implement the European One Health Action Plan against Antimicrobial Resistance. I call on everyone who has influence on the prevention and treatment of infections to redouble their efforts to combat this threat".

The studies showed that there still are sources of unnecessary use of antimicrobials in hospitals and in long-term care facilities. In hospitals, the proportion of broad-spectrum antimicrobials used varied from 16% to 62% across Europe. These medicines are not always necessary and their use drives antimicrobial resistance. In addition, more than 50% of antimicrobial courses for surgical prophylaxis, i.e. antimicrobials given to patients to prevent infections in relation with surgical procedures, lasted more than one day although continuing antimicrobial prophylaxis after the end of intervention is not recommended. In long-term care facilities, 29% of antimicrobials were prescribed for prophylaxis, and 74% of those courses were given to prevent urinary tract infections. While this might reduce the risk of infection in women, there is no evidence about its effectiveness when applied widely to elderly patients.

The surveys also confirm that healthcare-associated infections remain a public health issue in the EU/EEA. ECDC estimates that on any given day one in 15 patients in European hospitals, and one in 26 residents in long-term care facilities, have at least one healthcare-associated infection. Many of them were caused by multidrug-resistant bacteria.

Andrea Ammon, ECDC Director, stated: "With 33000 deaths each year as a consequence of an infection due to bacteria resistant to antimicrobials and EUR 1 billion in annual healthcare expenditure, we need to ensure that these medicines are used prudently and that infection prevention and control measures are in place in all healthcare settings across Europe". She added: "Since the rates of antimicrobial resistance, the rates of antimicrobial consumption as well as infection prevention and control practices vary from country to country, it is essential to tailor strategies to address specific needs. ECDC calls for continued action at all levels".

Zsuzsanna Jakab, WHO Regional Director for Europe said: "Human, animal, and environment health are all equally responsible for the correct use of antimicrobials and to avert the threat of antimicrobial resistance. As we strive to ensure that these medicines are rightly used in the community and in healthcare settings, one sector alone will not solve the problem. "One Health" brings together professionals in human, animal, food and environment health as one force, and as such is the only way to keep antimicrobials working. I call on all European countries to secure the highest commitment to this approach from the whole of society and the whole of government".

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Notes to the editor:

The ECDC findings are available on Eurosurveillance, a European peer-reviewed scientific journal devoted to the epidemiology, surveillance, prevention and control of communicable diseases, with a focus on such topics that are of relevance to Europe. https://www.eurosurveillance.org/ https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2018.23.46.1800393 https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2018.23.46.1800394

Data from the European Antimicrobial Resistance Surveillance Network (EARS-Net) for 2017 show that the situation concerning antimicrobial resistance in Europe displays wide variations depending on the bacterial species, antimicrobial group and geographical region. For several bacterial species and – antimicrobial group combinations, a north-to-south and west-to-east gradient is evident. In general, lower resistance percentages were reported by countries in the north while higher percentages were reported in the south and east of Europe. The latest country-specific data can be retrieved from the ECDC Surveillance Atlas of Infectious Diseases at https://atlas.ecdc.europa.eu/

Data from the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) show that from 2013 to 2017, no statistically significant change was observed for the EU/EEA overall regarding antimicrobial consumption in the community. However, statistically decreasing trends were observed for Finland, Germany, Italy, Luxembourg, the Netherlands, Norway, Sweden and the United Kingdom. In the hospital sector no statistically significant change was observed for the EU/EEA overall in the same timeframe. However, statistically significant increasing trends were observed for Croatia and Malta, and a statistically significant decreasing trend was observed for Finland. The most recent data on antimicrobial consumption are available from the public ESAC-Net interactive database (data for 1997?2017).

An ECDC study on the health burden of antibiotic resistance, published on 5 November 2018, estimated that about 33000 people die each year in the EU/EEA as a direct consequence of an infection due to bacteria resistant to antibiotics and that the burden of these infections is comparable to that of influenza, tuberculosis and HIV/AIDS combined. It also explains that 75% of the burden of disease is due to healthcare-associated infections (HAIs) and that reducing this through adequate infection prevention and control measures, as well as antibiotic stewardship, could be an achievable goal in healthcare settings. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30605-4/fulltext

Point-prevalence survey: A prevalence survey is a count of the number of patients with a particular condition/treatment (in this case either a healthcare-associated infection or an antimicrobial agent) at a particular time (in this case a day), as a proportion of the total number of patients who are hospitalised at that particular time. A point prevalence survey only counts the condition/treatment if present at the time (on the day) of the survey, but does not count it if present at other times during the patient stay in the hospital.

In 2016-2017, ECDC coordinated the second point-prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. Twenty-eight EU/EEA countries and Serbia participated.

In the same years, ECDC coordinated the third point-prevalence survey of healthcare-associated infections and antimicrobial use in European long-term care facilities. Twenty-three EU/EEA countries, the Former Yugoslav Republic of Macedonia and Serbia participated.

European Antibiotic Awareness Day

European Antibiotic Awareness Day (EAAD) is a European health initiative coordinated by ECDC, which provides a platform and support for national campaigns on the prudent use of antibiotics. Each year, EAAD is marked by national campaigns during the week of 18 November. Prudent use means only using antibiotics when they are needed, with the correct dose, dosage intervals and duration of the course http://antibiotic.ecdc.europa.eu.

On 15 November 2018 from 09.00 to 13.00 CET, an event called "One Health to Keep Antibiotics Working" will take place in Brussels, Belgium. The event is organised by ECDC in coordination with the European Commission. Event participants include professional organisations with an interest in antibiotic resistance, representatives from EU/EEA Member States and national and Brussels-based media. Watch the live stream on ECDC's YouTube channel or EAAD's Facebook page. The panel will respond to questions using the hashtag #EAAD.

World Antibiotic Awareness Week

In 2018, the WHO Regional Office for Europe focuses its WAAW on how One Health can help reduce antimicrobial resistance as a one-government approach. The One Health approach recognises that human, animal and environment health cannot be separated and that working across sectors can bring real progress. Follow the hashtag #AntibioticResistance. http://www.who.int/campaigns/world-antibiotic-awareness-week/en/.